MN Advantage Health Plan from Minnesota Management and Budget on Vimeo.

Minnesota Advantage Health Plan is the health insurance coverage for state employees, and retirees under age 65 and/or not eligible for Medicare. Employees may choose between Blue Cross or HealthPartners. Visit Blue Cross and Blue Shield of Minnesota and HealthPartners for more information. You'll find benefit summaries and informative videos on each website. See the Assigning a Primary Care Clinic (PCC) section below to view Cost Levels for your clinic.

As a new employee, your elections must be completed by 11:59 pm within 30 days of your hire date. Elections are completed within the Self Service Portal once you have your State ID by clicking Benefits ➡️ Benefits Onboarding.

• If you do not have access to enroll on your portal, please contact SEGIP at 651-355-0100.
• If you take NO action by your deadline, you will be automatically enrolled in the benefits defined below without the opportunity to choose your preferred carrier. You will not be able to enroll any dependent(s) in coverages until the next Open Enrollment OR until you experience a qualifying life event.

Effective Coverage Date:

Your elections become effective your 31st day of employment. Coverage requiring evidence of insurability is effective immediately after underwriting approval. Review your upcoming paycheck(s) to verify premium deductions. You may see back-charges based on the effective date of your insurance.

Enrollment method:

• If you are electing medical coverage, complete your enrollment in Employee Self Service by selecting Benefits ➡️ Benefits Onboarding.
• If you receive the full employer contribution and want to waive medical coverage, submit the waiver of medical coverage form to SEGIP.

Open Enrollment:

Open Enrollment is conducted annually, when employees may change their benefits. Outside of the Open Enrollment period, no changes may be made except in the case of a qualifying family status change.

Choosing the right clinic is an important part of your health care coverage. If you're enrolled in medical insurance through the Minnesota Advantage Health Plan, you must select a Primary Care Clinic (PCC). The cost level of that clinic determines in part how much you pay when you get care. Minnesota Advantage Health Plan administrators are Blue Cross and Blue Shield of Minnesota and HealthPartners. They contract with a network of Primary Care Clinics (PCC) and specialty care providers. 

Search for a Clinic

• View primary care clinic cost levels and find the clinic number you may need to enroll.
• You may search by city, ZIP code, or landmark
• Filter by cost level or health plan administrator (Blue Cross Blue Shield or HealthPartners)
• Selecting a Cost Level 1 or 2 clinic can help lower your out-of-pocket costs.

The Minnesota Advantage Health Plan Clinic Directory includes only primary care clinics and clinics with pediatricians. For information on specific doctors or specialists (including OB/GYNs, chiropractors, mental health providers, and others) use the hot links below for plan administrator's directories.

Blue Cross and Blue Shield of MN
HealthPartners

If You have qualified dependents covered by this Plan, each family Member may choose their own PCC, but the PCC must be offered through your Health Plan Administrator.

Clinics outside of the Advantage Plan’s Service Area and in the National Network of your selected Health Plan Administrator will be paid at the Out-of-Area benefit level.

Need Help?

To compare clinic quality, visit MN Health Scores. If you want to change your PCC during the year, just call the number on the back of your Blue Cross and Blue Shield of Minnesota or HealthPartners ID card.

People covered by the state’s employee medical plans may need two kinds of prior approvals to get certain care or medications: prior authorization and insurance referrals.

Prior Authorization

Doctors usually ask for this approval. They send the forms and follow the plan’s rules. If you don’t get approval first, your insurance might not pay for the service or medicine.

Blue Cross and Blue Shield of Minnesota

To review prior authorization and notification requirements for medications covered by Blue Cross and Blue Shield of Minnesota:

1. Visit the Blue Cross and Blue Shield of Minnesota website.
2. Scroll to the section titled “See the full lists of prior authorization and notification requirements” located in the right-hand column.
3. Click on “Commercial Prior Authorization and Notification List.”

This list includes medications that are covered through Blue Cross. If the medication you’re looking for is not listed, please visit the CVS Caremark website for additional coverage information.

HealthPartners

To review coverage rules and prior authorization requirements for HealthPartners:

1. Visit the HealthPartners website.
2. Scroll to the section titled “Search our coverage criteria.”
3. Use the following search filters:
   • Product: Minnesota
   • Prior authorization required: Yes

Note: Many of the pharmacy policies shown in this search may not apply to coverage through SEGIP. For accurate information regarding pharmacy prior authorizations, please visit the CVS Caremark website.

Insurance Referrals

To see most specialists, you’ll need a referral from your Primary Care Clinic (PCC). Your PCC is the clinic you selected when enrolling in your health plan, and it’s listed as your Primary Care Provider (PCP) on your medical insurance ID card.

To request a referral:

• Contact your PCC and ask for a medical insurance referral.
• Referrals are often required for your insurance to cover care from many specialty providers.

No Referral Needed:

You can go directly to the following providers within your HealthPartners or Blue Cross network—no referral required:

• Obstetricians/Gynecologists (OB/GYNs)
• Chiropractors (for acute care)
• Mental health providers
• Substance use disorder providers
• Eye doctors (for routine eye exams)

Also, you do not need a referral for care you get in an emergency room or at urgent care.

The provider must be in your Blue Cross or HealthPartners network. If you see a provider who is not in your network, you pay the entire bill yourself. The Minnesota Advantage Health Plan does not have coverage for out-of-network care. Take a look at real-life common situations where people end up paying their entire medical bill because they didn’t start with their PCC. Call the number on the back of your Blue Cross or HealthPartners ID card if you have any questions.

For more details, visit the Official Plan Documents section on SEGIP's website and select the Summary of Benefits.

CVS Caremark administers prescription drug benefits for all employees and their covered family members enrolled in the State of Minnesota’s medical plans. You'll also hear CVS Caremark referred to as the Pharmacy Benefits Manager or PBM.

Understanding the Formulary

The formulary is a list of approved medications, organized into cost levels. What you pay depends on the medication’s tier and quantity prescribed.

Common Cost Tiers:

• Generic Medications
  • Preferred/Formulary Generic: Offers the best overall value. Typically has the lowest copay for a 30-day supply.
  • Nonformulary Generic: Pricing varies. For accurate cost estimates, log in to your CVS Caremark account and search by drug name and ZIP code.

• Brand Medications
  • Preferred/Formulary Brand: Moderate copay for a 30-day supply.
  • Nonpreferred Brand: Highest cost copay for a 30-day supply.
  • Nonformulary Brand: Pricing varies. Use your CVS Caremark account to search by drug name and ZIP code for current pricing.

Additional Information:

• Diabetes Medications: Copays may differ for medications related to diabetes. See the Advantage Value for Diabetes drug list for details.

• ID Card: CVS Caremark will send you a prescription drug ID card, regardless of whether your medical plan is through Blue Cross or HealthPartners.

• Annual Out-of-Pocket Maximums:
  • Individual and family coverage have annual limits. These limits help protect you from excessive out-of-pocket costs for covered medications. Review plan details for the exact annual out-of-pocket costs.

• Pharmacy Network: You can fill most prescriptions at any pharmacy in the CVS Caremark network, including many non-CVS locations.

• Specialty Medications: These must be filled through CVS Specialty. Specialty drugs are typically used to treat complex or chronic conditions. Learn more.

Diabetes Care

Advantage Value for Diabetes – Supporting Your Health

If you have diabetes, this benefit is designed to help you manage your condition and reduce the risk of complications. The Advantage Value for Diabetes pilot program offers low-cost or no-cost access to essential diabetes-related care, including:

• Physician office visits
• Appointments with diabetes educators and dietitians
• Laboratory tests
• Consultations with pharmacists

You’ll also receive savings on prescription medications used to treat:

• Diabetes
• High blood pressure (hypertension)
• High cholesterol
• Depression

In addition, the program covers diabetes testing supplies at reduced or no cost.

Personalized Support Through Omada

If you have type 1 or type 2 diabetes and are enrolled in the Minnesota Advantage Health Plan, you may also be eligible for personalized support through Omada, including access to a personal health coach and a certified diabetes educator.

Fertility Treatments

Showing Support for Growing Families

Fertility insurance benefits are available to support individuals and couples who are trying to conceive or carry a pregnancy to term. Fertility treatments also includes IVF.

• Answer your questions
• Help you compare treatment options
• Provide personalized support throughout your fertility journey

No infertility diagnosis is required to access these fertility care services.

Mental Health Support

Mental health services are more accessible and affordable for employees and their covered family members under the Minnesota Advantage Health Plan.

Benefit Highlights:

• No-cost office visits for certain mental health services when your Primary Care Clinic (PCC) is in Cost Level 1 or 2.
• Reduced copayments for eligible visits when your PCC is in Cost Level 3 or 4.
  • Note: You must meet your deductible before insurance begins to cover these services.

Access to Care:

• You can see any in-network mental health provider—no referral required from your PCC.
• Explore a variety of mental health care options, including virtual care services.

Mental Health and Substance Use Care

Employees and their covered family members can access mental health and substance use disorder services through any provider within the Blue Cross or HealthPartners network.

Key Benefits:

• No referral or preapproval required from your primary care provider to access care.
• Online therapy options are available through various clinics across Minnesota, as well as virtual care platforms like Doctors on Demand and Teladoc.
• Cost savings are available based on your Primary Care Clinic’s Cost Level:
  • Cost Level 1 or 2: You may pay no out-of-pocket cost for eligible office visits. Deductibles may not apply unless you're enrolled in a High Deductible Health Plan.
  • Cost Level 3 or 4: You may receive discounted rates for eligible office visits. Deductibles may apply.

Coverage Tip:

• To ensure your online provider is covered, check with Blue Cross or HealthPartners to confirm network participation.

Explore your options and learn more about available mental health and substance use care services, including virtual care.

Online Care Options

Convenient, Covered, and Cost-Free

You can access online medical care at no cost through the following services:

• Doctors on Demand
• virtuwell
• Teladoc (available if HealthPartners is your plan administrator)

These services do not require a referral, no copay is charged, and insurance may cover the entire cost of the visit—even if you haven’t met your deductible.

Exception: If you’re enrolled in the Advantage High Deductible Plan, you must meet your deductible before coverage begins.

Note: Online care for the same medical concern through other clinics—including your primary care clinic—may not be fully covered and could result in out-of-pocket costs.

To avoid unexpected charges, call the number on the back of your Blue Cross or HealthPartners ID card to confirm which online care options are fully covered.

Convenience Care Options

Easy Access to Affordable Care

Before visiting a convenience clinic, contact Blue Cross or HealthPartners to confirm which clinics are considered in-network. (Note: Not all clinics that call themselves “convenient” meet your plan’s definition of a Convenience Clinic.) A quick phone call can help you avoid unexpected bills.

What You Need to Know:

Most employees and family members covered by the Minnesota Advantage Health Plan pay nothing for care at in-network convenience clinics. Including:

• No Copay
• Insurance pays even if you haven't met your deductible

If you’re enrolled in the High Deductible Plan, you must meet your full deductible before care at a convenience clinic is covered at no cost.

Why Use a Convenience Clinic?

• Lower cost for you and the state
• Care provided by nurse practitioners or physician assistants
• Ideal for simple illnesses, basic tests, and vaccinations
• No appointment usually needed

Travel Benefits

Support for Long-Distance Medical Care

If the care you need is located more than 100 miles from your home, the travel benefit may help cover expenses such as lodging and other travel-related costs.

This benefit is designed to support access to necessary medical care when local options are not available.

Note: The travel benefit does not apply to routine office visits or when online care is a suitable alternative. 

For all other information:

Please visit the State Employee Group Insurance Plan's website for more details on medical benefits, schedule of benefits, rates, summaries, and more!